Final Blog

Ever since my cousin passed away in 1998, I have been furthering my education about melanoma. However, I have only looked up how the cancer comes about and progresses; never have I researched the methods in how to either prolong a person's life or cure the patient altogether. I was completely shocked when I came across the number of ways to fight melanoma. 

Of all the methods that I researched, I believe the one that will  make the most impact will be the MelaFind.  Every week when I was looking up another technology, I would find a new article about the MelaFind. I have even asked my parents if I would be allowed to try it out if I can find a practice in Arizona that uses the technology. What impresses me most about this lazer-gun looking tool is that it is able to take a picture of a suspicious mole for a dermatologist to determine whether or not surgery needs to be performed - no biopsy is needed. For me, the biopsy is just as painful as the surgery; I even passed out during one of my biopsies. What makes a biopsy worse is that you are left with a scar, regardless if you needed the second surgery or not. The MelaFind takes out the need for a biopsy, and you know if you need surgery that day rather than waiting 7-10 days for the biopsy results. Having to wait is one of the worst parts of receiving news. The only downside is that the MelaFind is not yet covered by insurance, so I would have to pay $100 out-of-pocket to use the tool. 

To me, the least beneficial method is Mole Mapping. With this method, a person's moles are mapped out to track any changes, itchiness, tenderness or concern for a particular mole. The pictures are sent to other dermatologists for analysis and stored in a database for future comparisons. However, a biopsy would still need to be performed if something looked suspicious to a doctor. Additionally, mole mapping is incredibly expensive. The cheapest consultation, which only covers 3 moles and 15 minutes with a doctor, is $130. Consultations can cost as much as $300 for a first time visit and up to $285 for follow up patients. This would be an ongoing fee for people who have a high mole count. I do not believe that this service is worth the cost. Other technologies are cheaper and just as, if not more, effective.

The technology that surprised me the most was the mobile application. People always joke about there being an app for everything; this even holds true for "detecting" melanoma. What is most frustrating to me is that people actually believe that this is an acceptable way to check themselves for cancer. Users send in pictures of moles via their phones and receive a response from a dermatologist. However, the accuracy of the results vary greatly. The best apps diagnose cancerous moles with a 98.1% accuracy, and the worst apps detect melanoma with 6.8% accuracy. Taking a picture and sending it in is a free and convenient service, but the only way to know for sure if a person has melanoma is to physically see a doctor.

I only see melanoma technology improving for the future, whether it be in 1, 5 or 10 years. With all the new advances being made in medicine, I would not be surprised if another technology would spring up in a few years or if there would be an improvement on the current ones that I researched. Previously, melanoma has only been treated by means of chemotherapy. I have found and researched a variety of different methods that can help a person either live longer than expected or be completely cured from melanoma. I believe that as time goes on, doctors will find a way to decrease the cost of these treatments while working on new ones as well.  I am hopeful for what the future will bring when it comes to curing patients with melanoma.  

This blog has opened my eyes to a different side of melanoma. I can now not only inform people about the dangers of the cancer, but also tell them that there are ways to cure it should a person find out he or she has the disease. I will continue to raise awareness about melanoma. 

Updates on my scars:

On my leg

On my back

Immunotherapy

There are a variety of immunotherapy treatments to help patients with treating advanced melanoma. Immunotherapy is the prevention or treatment of disease with substances that stimulate the immune response. It helps a patient’s own immune system to detect and destroy cancer cells on its own. Newer forms of immunotherapy are available only through clinical trials.

 

Ipilimumab for advanced melanoma

· Man-made version of an immune system protein

· Boosts the immune response against melanoma cells

· Given through an IV once every 3 weeks for 4 treatments

· For patients who can’t have melanoma removed by surgery or it has already spread, it can help these patients live several months longer

· Does not cure melanoma

· Helps against cancer cells, but could lead to problems in in the intestines, liver, hormone-making glands, nerves, skin, eyes, or other organs.

· Immune-related side effects occur during treatment, but can last a few months post-treatment

 

Cytokines for advanced melanoma

· Proteins in the body that boost the immune system

· Can either be given via IV or by injection at home

· Helps shrink advanced melanoma (stage 3 & 4) by 10-20%

· Can be given alongside chemotherapy for stage 4 melanoma

· Side effects: flu-like symptoms (fever, chills, aches, sever tiredness, drowsiness, and low blood cell counts), swelling from fluid build up

· Only given in centers with high experience of this treatment

 

Interferon-alpha as adjuvant therapy

· Is used after surgery for patients with thicker melanomas to try to prevent the cells from spreading and growing

· Delays recurrence of melanoma, but not sure yet if it helps improve survival

· Needs to be had in high doses

· Side effects: fever, chills, aches, depression, severe tiredness, and effects on the heart and liver.

· Patients need to be closely watched by doctors greatly experienced in this treatment

 

Bacille Calmette-Guerin (BCG) vaccine

· Enhances the entire immune system, but is not directed specifically at melanoma cells

· Used to help treat stage 3 melanoma by directly injecting it into tumors

Imiquimod cream

· Stimulates a local immune response against skin cancer cells when applied as a cream

· Can be used for very early stages of melanoma (stage 0) in sensitive areas on the face in place of surgery that could cause disfiguration to the face

· Used for melanomas that have spread along the skin

· Applied anywhere on the body once a day to two times a week for three months

· Patients may have irritation or skin reactions to the cream

· Not used nor recommended for advanced melanomas

Mole Mapping

MoleMap is a company that uses mole mapping as a way to detect melanoma at an early stage.  Patients first meet with a Melanographer, a nurse trained in skin cancer and dermoscopic imaging, for a one hour consultation.  At this time, the moles are “mapped” out using imaging technology to create a map of where the moles are located on a person’s body. By utilizing skin surface microscopy, any suspicious mole or lesion found is digitally imaged. Recordings are taken down about any changes, itchiness, tenderness or concern for a particular mole or lesion image. MoleMap also offers getting a MoleSnap. MoleSnap is the same as a mole mapping, only it lasts 15 minutes and only focuses on 3 moles that the patient is concerned about.

After a mole map is done, the images and descriptions are sent to international specialist dermatologists. These images are archived on a remote database for storage to be used later for mole comparisons. The dermatologists prepare one report for the patient and one for the doctor. The report identifies if there are any moles or lesions of concern, along with management of the moles or any recommendations, such as just keeping a watchful eye on the mole or going forth with surgery.

MoleMap also uses Total Body Photography (TBP), Digital Dermoscopy, and Digital Serial Monitoring as methods for detecting melanoma. TBP creates a complete record of your skin and is used for managing at-risk patients with a high number of moles. This method helps identify new moles and subtle changes in existing moles that may have gone unnoticed. Digital Dermoscopy combines high magnification and light intensity to illuminate what is underneath a persons’ skin; things you cannot see with the naked eye. Dermoscopy allows for more accuracy in diagnosing melanoma and reduces the need for unnecessary biopsies. Digital Serial Monitoring allows for tracking moles over a period of time. This process is useful for identifying moles that look normal and would otherwise be missed by a routine clinical observation.

Pricing is as follows:

·         New Patients: 60 minute consultation appointment: $300

·         Follow up patients (with low mole count): $220

·         Follow up patients (with moderate mole count): $260

·         Follow up patients (with high mole count): $285

·         Children (under 12): 30 minute consultation appointment: $130

·         MoleSnap: 15 minute consultation appointment: $130

Tanning Obsessions

We hear clips on the news about how the sun affects our skin, but these news features are typically a minute or two long. Other TV shows are now starting to show how tanning is becoming an obsession among young people. On TLC's My Strange Addiction, Tricia and Samantha tell their stories about how they love tanning. The girls admit that they are aware of the consequences of what the tanning booths will do to their skin, but both believe that because nothing has happened so far that they will be safe in the future. 

Tricia

Samantha

Tricia and Samantha both found a way to tan multiple times a day. It is illegal for tanning salons to allow customers to tan more than once per day at their salons. What each girl does is sign up at numerous salons, going from one salon to the next each day - Samantha visited up to 5 salons per day. What the salons need to do is check with the other salons to see if they have matching clients. Every time a person tans in a tanning bed, he or she becomes eight times more likely to get skin cancer. If these girls are rotating around, they are exponentially increasing their chances...daily.

Both girls are so concerned with their appearances that they overlook what will happen in the future. Tricia admits that she doesn't care about dying earlier, as long as she looks tan. Samantha says in her feature that though she knows tanning will age her faster, there are cosmetic surgeries to help fix her problems. The one aspect that each episode has in common is neither girl seems concerned about getting skin cancer. 

At the end of each My Strange Addiction episode, there is an update on the featured person. Both girls found out that they do not have cancer from dermatologists, but they also found out what will happen should they continue on in the decisions they are making. For full episodes, check out My Strange Addiction on TLC. MTV has also held a casting call for their show True Life: I'm Addicted to Tanning.

These episodes, in a way, serve as a Public Service Announcement. Many viewers will see just how tanning can change their lives. If they do not take extra precautions, they could be slowly killing themselves, and possibly using one of the technologies in previous posts to get rid of the melanoma. The easiest way to avoid this problem is to avoid the tanning bed.

A Failed Technology?

People are addicted to downloading new apps to their phones to enhance what they can do on their androids or iPhones. There is always a risk when it comes to downloading an app - how well it will work and how much satisfaction it will bring. But what about an app that can help detect skin cancer?

There are multiple apps that claim to detect skin cancer. People take a picture of a suspicious mole on their body and send it to be analyzed, and the application determines whether or not the mole is cancerous. Sure, this seems like a cheaper, easier, and more convenient solution to having to go to the dermatologist. However, studies at the University of Pittsburgh Medical Center have shown that these apps postpone diagnosis and can be harmful instead of helpful. Four apps were tested, and on average, three of the four incorrectly diagnosed 30% or more melanomas.

Researchers studied 188 moles, 60 of which were diagnosed as melanoma by a dermatologist. When using the apps, the researchers found that the accuracy of the results varied greatly. The best apps were able to diagnose cancerous moles with a 98.1% accuracy, and the worst apps were only able to detect melanoma with 6.8% accuracy.  The app that has the highest accuracy for melanoma detection actually has the images sent to board-certified dermatologists, and the user received a response within 24 hours. However, according to Dr. Darrell Rigel, “…the difference between these and 'real' in-office melanoma diagnostic devices is the difference of a toy car versus a real car. One you play with, and the other works."

These apps state that they are good for helping users track suspicious moles on their body, and the disclaimers say that they are intended for educational purposes. However, dermatologists are concerned that people who are unable to afford a visit to an actual doctor are going to rely on these apps for melanoma detection. This is dangerous because the apps are incredibly inaccurate. If a person is concerned about a lesion on his or her body, it is important to go to a dermatologist.

The U.S. FDA announced in July 2011 that they would regulate apps that coincide with medical devices, and in 2012 Congress passed the FDA Safety and Innovation Act. This allows the FDA to regulate smartphone apps. It is important for the FDA to step in because with the accessibility of these apps, more people are going to rely on these for detection. 

Verisante Aura

The Aura, winner of the the Popular Science "Best of What's New" award in 2011, is a non-invasive tool that will help doctors determine if a skin lesion is cancerous and needs to be biopsied.  It helps provide information for the chemical composition of skin, providing results in under one second for 21 different cancer biomarkers. Not only does the Aura detect melanoma, but all other major skin cancers at with 99% sensitivity (detects 99% of skin cancers tested, with Melanoma being 34%). In addition to skin cancer, the Aura technology is also licensed for lung, colon, and cervical cancers. 

The first prototype was reconstructed to make a more compact, more producible, and more commercially attractive for doctors. The final product did not hit markets until Fall of 2012 so that the newest prototype could be tested before its massive sales launch. The builders of the product were convinced that the new prototype is better than the original as it produces better results. After successfully beta testing five Auras in Canada, Verisante created 25 units in October, 35 in November and 45 in December. The current target markets for the Aura include Canada, Germany, Switzerland, Austria and Australia, which has the highest cases of skin cancer in the world.

Brian Marckx, Zachs Investment Research analyst, believes that Verisant's Aura may be the "new gold standard for skin cancer diagnosis." Skin cancer is the most common form of cancer; 40-50% of Americans get skin cancer, and although Melanoma accounts for 4% of skin cancer, it is the cause of 75% of skin cancer deaths. Melanoma occurrences are increasing more than any other cancer, and the Aura hopes to eliminate this problem.  As shown by the chart, it is imperative that the Aura help detect Melanoma because if caught early, the chances for survival are greater. 

The Aura does have one major competitor in the market - the MelaFind. However, "While Aura can detect melanoma, squamous cell and basal cell carcinomas - two common types of non-melanoma skin cancers - and actinic keratosis, a premalignant skin condition, MelaFind is indicated for the detection of melanoma only." Aura also is not in the United States, and only takes one second to produce results whereas it takes two minutes for the MelaFind to scan a lesion.  Additionally, Aura has 99% sensitivity and 17% specificity, compared with 98% and 9.5% for the MelaFind. 

Aura's goal is to increase survival rates, reduce treatment costs, eliminate the need for biopsies, and decrease wait times for dermatologists because scans can be done by trained technicians. The Aura is currently awaiting FDA approval before the end of 2014.

   

Skin Analysis Machine

Similar to what I posted last week, the Skin Analysis Machine is able to detect problems before they reach the skin's surface. To use the machine, patients stick their cheeks inside the Skin Analysis Machine.  It then takes a 3D picture of the person's face and then compares it to 5000 other people of the same age and skin type. Wrinkles, crows feet, sun damage, pore size, skin damage and bacteria are all highlighted in the results.

The machine also has a way to show how your skin will progress in 10 years should you go without any kind of treatment. The doctor might prescribe a laser treatment to help treat sun damaged skin or an anti-wrinkle cream to treat lines on the person's face. To see how the Skin Analysis Machine works, click here.

There are ways to help slow down the aging process:
   - Avoid collagen: it doesn't actually help prevent wrinkles
   - Wear a sunblock with a SPF over 30: it helps protect your skin
   - Don't get facials: they actually increase your risk of a breakout on your skin
   - Eat the right foods: some foods, such as tomato paste, can help protect your skin from a              sunburn

You can find Skin Analysis Machines at doctors offices and medical spas. The cost is around $100, but can vary from doctor to doctor.